msjoymarie

Hello All- Im a longtime lurker and decided to register and create a thread today... I'm aware all health plans vary however I wanted to put ease in someone elses mind who may have a similiar employer health plan as me. I have Blue Shield of CA Access+ HMOSM Plan 20. When inquiring about coverage for lapband and any and all prerequisites that would need to be completed prior to surgery, this was the response I received: "Thank you for your inquiry. Medically necessary bariatric surgery is covered under your health plan. Blue Shield will provide benefits for medically necessary inpatient or outpatient bariatric surgery procedures to treat morbid or clinically severe obesity only if: Performed at designated preferred bariatric surgery facilities and by designated preferred bariatric surgery physicians that has contracted with Blue Shield to provide the procedure. The services are consistent with Blue Shield's Medical Policy. Prior authorization is obtained in writing. All bariatric surgery services must have prior authorization, in writing, from Blue Shield's Medical Director. Prior authorization is required for all persons. Non-Preferred Providers are covered only if prior authorization has been obtain. The laparoscopic and open adjustable silicone gastric bypass (Lap Band) procedure is eligible for coverage. Information needed for review (bariatric surgery): * Current History & Physical exam (within 6 weeks of surgery); * Procedure code; * Patient's current height & weight; * Patient's age; * Diet history; * Contributing medical conditions (diabetes, hypertension, joint pain, etc.) * Frame size (small, medium, large); * Body mass index (BMI); * Multidisciplinary team consults (medical, surgical, psychological and nutritional) * Name of facility where surgery is to be performed * Patient Address (street, city & county) * Proposed date of service The Personal Physician is responsible for providing primary care and coordination or arranging for referral to other necessary health care services and obtaining any needed prior authorization by your Medical Group/IPA or Blue Shield. Blue Shield covers acute inpatient services provided by a hospital. Services include general nursing care, semi-private room and board, and intensive care. Services must be medically necessary. Copayment: $1000.00 per admission.. The providers that see you at the facility will be a $0.00 copay. Aldo the lab services are a $0.00 copay per the benefits on the policy. The office visists will be $20.00 per visit." I am actually having my surgeon consult today @ Cedar Sinai. Good luck to all and hopefully this post helped.